D.C. Mun. Regs. r. 22-A3011

Current through Register Vol. 71, No. 25, June 21, 2024

Rule 22-A3011 - COMPLIANCE AND INTEGRITY PROGRAM

3011.1

Each provider shall establish and adhere to a plan for ensuring compliance with the Medicaid program and this regulation. Each provider shall submit its Corporate Compliance Plan and any modifications thereto to the Department as part of the certification or recertification process. At a minimum, the plan shall:

(a) Designate an officer or director with responsibility and authority to implement and oversee the operation of the Corporate Compliance Plan;

(b) Require initial, and, thereafter, quarterly exclusion checks on all employees to ensure no individual is excluded from participation in a federal health care program as found on the Department of Health and Human Services "List of Excluded Individuals/Entities" (http://oig.hhs.gov/fraud/exclusion.asp) or the General Services Administration "Excluded Parties List System" (http://www.wpls.gov) or the "District of Columbia Excluded Parties List" (http://ocp.dc.gov/DC/Excluded+Parties+List) maintained by the District's Debarment and Suspension Panel;

(c) Require that all officers, directors, managers, and employees enforce its provisions and receive annual compliance training;

(d) Include procedures designed to prevent and detect potential or suspected false claims, abuse or fraud in the administration and delivery of FSMHC services;

(e) Include procedures for the confidential reporting of violations of the Corporate Compliance Plan to the Department, including procedures for the investigation and follow-up of any reported violations;

(f) Require that the FSMHC conduct annual internal audit using RAT-STATS, a statistical software package provided free of charge by the U.S. Department of Health and Human Services Office of the Inspector General, or other comparable software program. The audit shall utilize statistically valid and random sampling and identify any overpayments. The error rate for each audit shall be calculated as provided in § 3012;

(g) Require the FSMHC provide a copy of the internal audit and all supporting documents to the Department and to repay any overpayments identified in the provider's internal audit within sixty (60) days;

(h) Ensure that the identities of individuals reporting suspected violations of the Corporate Compliance Plan are protected and that individuals reporting suspected violations, fraud, or abuse are not retaliated against;

(i) Require that confirmed violations of the compliance plan be reported to the Department within twenty-four (24) hours of confirmation;

(j) Require any confirmed or suspected fraud and abuse under District or Federal law or regulation be reported to the Department;

(k) Require cooperation with Department investigations of major unusual incidents, consumer deaths related to suicide, and the death of a child or youth consumer; and

(l) Require data reporting regarding key performance indicators published annually in the D.C. Register.

D.C. Mun. Regs. r. 22-A3011

Final Rulemaking published at 67 DCR 11929 (10/16/2020)